Lebanon County officials investigate drug overdoses

At least six people have overdosed and one person has died in the past two weeks after taking a drug they thought was heroin, but was actually synthetic fentanyl, according to Lebanon County officials.

Synthetic fentanyl, which is very lethal, looks like heroin. Fentanyl is a chronic pain reliever.

The drug was purchased locally, but officials are not sure where it was manufactured.

All of the victims are in their 20s. State police are involved in the investigation.

Photos: 25 facts about heroin

Photos: 25 facts about heroin

The 25 heroin facts in this slideshow are provided by the National Institute on Drug Abuse.

1: Heroin can be injected, inhaled by snorting or sniffing, or smoked. All three routes of administration deliver the drug to the brain very rapidly, which contributes to its health risks and to its high risk for addiction, which is a chronic relapsing disease caused by changes in the brain and characterized by uncontrollable drug-seeking no matter the consequences.

2: After an intravenous injection of heroin, users report feeling a surge of euphoria (“rush”) accompanied by dry mouth, a warm flushing of the skin, heaviness of the extremities, and clouded mental functioning. Following this initial euphoria, the user goes “on the nod,” an alternately wakeful and drowsy state.

3: Heroin is an opioid drug that is synthesized from morphine, a naturally occurring substance extracted from the seed pod of the Asian opium poppy plant. Heroin usually appears as a white or brown powder or as a black sticky substance, known as "black tar heroin."

4: In 2011, 4.2 million Americans aged 12 or older (or 1.6 percent) had used heroin at least once in their lives. It is estimated that about 23 percent of individuals who use heroin become dependent on it.

5: When it enters the brain, heroin is converted back into morphine, which binds to molecules on cells known as opioid receptors. These receptors are located in many areas of the brain (and in the body), especially those involved in the perception of pain and in reward. Opioid receptors are also located in the brain stem, which controls automatic processes critical for life, such as blood pressure, arousal, and respiration.

6: Heroin overdoses frequently involve a suppression of breathing, which can be fatal.

7: Regular heroin use changes the functioning of the brain. One result is tolerance, in which more of the drug is needed to achieve the same intensity of effect. Another result is dependence, character-ized by the need to continue use of the drug to avoid withdrawal symptoms.

8: Heroin abuse is associated with a number of serious health conditions, including fatal overdose, spontaneous abortion, and infectious diseases like hepatitis and HIV.

9: Chronic users may develop collapsed veins, infection of the heart lining and valves, abscesses, constipation and gastrointestinal cramping, and liver or kidney disease. Pulmonary complications, including various types of pneumonia, may result from the poor health of the user as well as from heroin’s effects on breathing.

10: In addition to the effects of the drug itself, street heroin often contains toxic contaminants or additives.

11: Many of the additives in street heroin may include substances that do not readily dissolve and result in clogging the blood vessels that lead to the lungs, liver, kidneys, or brain. This can cause infection or even death of small patches of cells in vital organs. Immune reactions to these or other contaminants can cause arthritis or other rheumatologic problems.

12: Chronic use of heroin leads to physical dependence, a state in which the body has adapted to the presence of the drug. If a dependent user reduces or stops use of the drug abruptly, he or she may experience severe symptoms of withdrawal. These symptoms—which can begin as early as a few hours after the last drug administration—can include restlessness, muscle and bone pain, insomnia, diarrhea and vomiting, cold flashes with goose bumps (“cold turkey”), and kicking movements (“kicking the habit”).

13: Besides the risk of spontaneous abortion, heroin abuse during pregnancy (together with related factors like poor nutrition and inadequate prenatal care) is also associated with low birth weight, an important risk factor for later delays in development. Additionally, if the mother is regularly abusing the drug, the infant may be born physically dependent on heroin and could suffer from neonatal abstinence syndrome (NAS), a drug withdrawal syndrome in infants that requires hospitalization.

14: Prescription opioid pain medications such as Oxycontin and Vicodin can have effects similar to heroin when taken in doses or in ways other than prescribed, and they are currently among the most commonly abused drugs in the United States. Research now suggests that abuse of these drugs may open the door to heroin abuse.

15: Nearly half of young people who inject heroin surveyed in three recent studies reported abusing prescription opioids before starting to use heroin. Some individuals reported taking up heroin because it is cheaper and easier to obtain than prescription opioids.

16: According to the 2003 National Survey on Drug Use and Health, which may actually underestimate illicit opiate (heroin) use, an estimated 3.7 million people had used heroin at some time in their lives, and over 119,000 of them reported using it within the month preceding the survey. An estimated 314,000 Americans used heroin in the past year, and the group that represented the highest number of those users were 26 or older.

17: The survey reported that, from 1995 through 2002, the annual number of new heroin users ranged from 121,000 to 164,000. During this period, most new users were age 18 or older (on average, 75 percent) and most were male. In 2003, 57.4 percent of past year heroin users were classified with dependence on or abuse of heroin, and an estimated 281,000 persons received treatment for heroin abuse.

18: According to the Monitoring the Future survey, NIDA's nationwide annual survey of drug use among the Nation's 8th-, 10th-, and 12th-graders, heroin use remained stable from 2003 to 2004. Lifetime heroin use measured 1.6 percent among 8th-graders and 1.5 percent among 10th- and 12th-graders.

19: Injection drug users (IDUs) represent the highest risk group for acquiring Hepatitis C infections; an estimated 70 to 80 percent of the 35,000 new Hepatitis C infections occurring in the United States each year are among IDUs.

20: A variety of effective treatments are available for heroin addiction. Treatment tends to be more effective when heroin abuse is identified early. The treatments that follow vary depending on the individual, but methadone, a synthetic opiate that blocks the effects of heroin and eliminates withdrawal symptoms, has a proven record of success for people addicted to heroin. Other pharmaceutical approaches, such as buprenorphine, and many behavioral therapies also are used for treating heroin addiction.

21: Detoxification programs aim to achieve safe and humane withdrawal from opiates by minimizing the severity of withdrawal symptoms and other medical complications. The primary objective of detoxification is to relieve withdrawal symptoms while patients adjust to a drug-free state.

22: Opiate withdrawal is rarely fatal. It is characterized by acute withdrawal symptoms which peak 48 to 72 hours after the last opiate dose and disappear within 7 to 10 days, to be followed by a longer term abstinence syndrome of general malaise and opioid craving.

23: There are drug analogs for heroin. Drug analogs are chemical compounds that are similar to other drugs in their effects but differ slightly in their chemical structure. Some analogs are produced by pharmaceutical companies for legitimate medical reasons. Other analogs, sometimes referred to as "designer" drugs, can be produced in illegal laboratories and are often more dangerous and potent than the original drug.

24: Two of the most commonly known opioid analogs are fentanyl and meperidine (marketed under the brand name Demerol, for example).

25: Fentanyl was introduced in 1968 by a Belgian pharmaceutical company as a synthetic narcotic to be used as an analgesic in surgical procedures because of its minimal effects on the heart. Fentanyl is particularly dangerous because it is 50 times more potent than heroin and can rapidly stop respiration. This is not a problem during surgical procedures because machines are used to help patients breathe. On the street, however, users have been found dead with the needle used to inject the drug still in his or her arm.

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